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Observational Study
. 2025 Apr;44(4):905-914.
doi: 10.1007/s10096-025-05059-y. Epub 2025 Feb 8.

Which antimicrobial treatment for patients with bloodstream infection during ECMO support?

Nicolas Massart  1   2 , Sofia Ortuno  3 , Charles Vidal  4 , Samuel Henri  5 , Hadrien Rozé  6 , Adrien Bouglé  7 , Francesca Manicone  8   9 , Frank Bidar  10 , Benjamin Assouline  11 , Paul Masi  12 , Sami Hraiech  13 , Nicolas Nesseler  14   15   16 , Etienne de Montmollin  17 , Charles-Edouard Luyt  3   18
Affiliations
Free article
Observational Study

Which antimicrobial treatment for patients with bloodstream infection during ECMO support?

Nicolas Massart et al. Eur J Clin Microbiol Infect Dis. 2025 Apr.
Free article

Abstract

Ojective: We aim to describe a large, multicenter cohort of patients with bloodstream infection (BSI) acquired during extracorporeal membrane oxygenation (ECMO) support.

Methods: We conducted a retrospective observational study in 12 Europeans ICUs. Only patients who developed a BSI of unknown source during ECMO support were included in the present analysis. Primary aim was to describe BSI epidemiology in patients with ECMO support. Secondary objectives were to describe antimicrobial susceptibility of incriminated micro-organisms.

Results: One hundred and eighty-two patients were included. Main reason for ECMO support was ARDS, followed by cardiogenic shock and post-cardiotomy. Half of the patients (51.9%) received early antimicrobial therapy. Main incriminated microorganisms were Enterococcus sp. (37.4%), Enterobacterales (26.9%), coagulase negative Staphylococci (15.9%) and Gram negative bacilli (11.5%). Multi drug resistant organisms (MDRO) were incriminated in 26 (14.3%) BSI and were mainly extended spectrum producing-Enterobacterales (17/26). Antimicrobial therapy was considered as appropriate in 130 patients (71.4%). Patients who received inappropriate antimicrobial therapy were more frequently infected with MDRO. Only 59 (32.4%) of cases were susceptible to 3rd generation cephalosporin while association of piperacillin/tazobactam with vancomycin was considered appropriate in 155 cases (85.2%) as compared with 168 cases (92.3%) for carbapenems combined with vancomycin.

Conclusion: Enterococcus sp. was incriminated in about a third of BSI among patients with ECMO support. High appropriateness would only be obtained with piperacilline/tazobactam or carbapenems in association with vancomycin while 3rd generation cephalosporin would have failed in the majority of BSI cases.

Clinical trial number: Not applicable.

Keywords: Antimicrobial agent; Bacteremia; Extra corporal membrane oxygenation; Hospital acquired infection.

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Conflict of interest statement

Declarations. Ethics approval: In accordance with the declaration of Helsinki, the protocol was submitted and then approved by the ethics committee of the Société de Réanimation de Langue Française (registration no. CE-SRLF-22–074) and the database is registered by the Commission Nationale de l’Informatique et des Libertés (CNIL, registration no 2228484v 0). Consent to participate: In accordance with current French law, informed written consent for demographic, physiologic and hospital-outcome data analyses was waived because this observational study did not modify existing diagnostic or therapeutic strategies. Nonetheless, patients and/or relatives were informed about the anonymous data collection and told that they could decline inclusion. Competing interests: The authors declare no competing interests. Contributors: Groupe Hospitalier Pitié-Salpêtrière, Paris, France: Juliette Chommeloux, Guillaume Hékimian, Alain Combes, Nima Djavidi, Aymeric Lancelot, Pauline Dureau, Guillaume Lebreton. CH de Saint-Brieuc, France: Pierre Fillâtre. Centre Hospitalier Universitaire de La Réunion, Saint Denis, France: Laura Rivoire, Nicolas Allou, Radj Cally. Hôpital Bichat-Claude Bernard, Paris, France: Hermann Do Rego, Mariem Dlela, Marc Doman. Centre Hospitalier universitaire de Rennes: Christophe Camus, Erwan Flecher, Alexandre Mansour. Hôpital Louis Pradel, Lyon, France: Jean-Luc Fellahi, Matteo Pozzi, Matthias Jacquet-Lagreze. Hôpitaux Universitaires de Genève, Genève, Switzerland: Raphaël Giraud, Karim Bendjelid. Hôpital Henri Mondor, Créteil, France: Keyvan Razazi, Armand Mekontso-Dessap. Hôpital universitaire de Lille, Lille, France: Anahita Rouzé, Saad Nseir, Thibault Duburcq. Hôpital Nord, Marseille, France: Christophe Guervilly, Jean-Marie Forel. Hôpital Haut Leveque, Pessac, France: Eline Bonnardel. Hôpital Universitaire de Bruxelles, Brussels, Belgium: Fabio S Taccone. Central message: Among ECMO patients with bloodstream infection, incriminated microorganisms were dominated by Enterococcus sp., Enterobacterales and coagulase negative Staphylococci. Mortality was high (50%). Perspective statement: Base on observed microbiology, high appropriateness would only be obtained with piperacilline/tazobactam or carbapenems in association with vancomycin. Future trial evaluating empirical therapy in this setting are needed.

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